Status: Full Time
Shift: varies; typically, 8am-4:30pm Monday-Friday, occasional weekend day
Exempt: No
Summary:
The Clinical Liaison serves as a key connector among referral sources, patients, and payors, leveraging clinical expertise to advocate for patient access to rehabilitation services. This role combines responsibilities for building referral relationships, coordinating pre-admission screenings, and assisting with the management of insurance denials through comprehensive appeals. Additionally, the role collaborates closely with the IRF Leadership and Intake staff to ensure a seamless admission process, accurate documentation, and compliance with regulatory requirements.
Other information:
Qualifications:
- Licensure/Certification: Current clinical licensure required (one of the following RN, AND, BSN, or MSN )
- Experience:
- Minimum 2 years of clinical experience, preferably in an Inpatient Rehabilitation Hospital setting, or Case Management. (IRF nursing not required, but preferred)
- Prior experience in marketing/sales or referral development preferred.
- Experience with insurance appeals and medical necessity documentation; strongly preferred.
- Skills:
- Excellent oral and written communication and interpersonal skills.
- Strong clinical assessment skills and proficiency with EMR systems.
- Ability to analyze medical records and author professional clinical narratives supporting necessity of IRF admission criterium.
- Formal sales training, customer service and quality improvement experiences are preferred.
Responsibilities:
Key Responsibilities:
Referral Development & Pre-Admission Coordination
- Build and maintain strong relationships with physicians, case managers, discharge planners, and payors to drive appropriate admissions.
- Assist and coordinate the intake and pre-admission screening process with emphasis on external referral sources
- Conduct on-site clinical assessments at referring facilities to determine suitability for acute rehabilitation.
- Educate patients and families on rehabilitation options, level of care, and participation requirements.
- Serve as the initial external contact for case managers, discharge planners, and hospital partners.
- Conduct face-to-face educational visits and in-services with healthcare professionals to communicate IRF admission processes.
- Document screenings, decisions, and communications accurately in EMR and/or tracking systems.
- Functions on behalf of the IRF as the vendor liaison for all Home Health, Home Care, Hospice, SNF, and Assisted Living service providers.
Collaboration with Intake Coordinator
- Partner with the Intake Coordinator to ensure accurate and timely completion of pre-admission paperwork and requirements.
- Share clinical insights during admission screenings to support appropriate placement decisions.
- Assist in managing referral waitlists by providing clinical input on prioritization.
- Communicate proactively regarding Medicaid screenings, Medicare criteria, and regulatory changes impacting admissions.
- Participate in interdisciplinary team meetings and case reviews to align treatment plans and admission strategies.
- Support the Intake Coordinator in maintaining compliance with MDS and RAI processes by providing clinical documentation as needed.
Clinical Appeals & Advocacy
- Assist with the review of denied insurance claims for medical treatment and analyze patient medical records to determine if the denial was justified.
- Understand and apply federal requirements for inpatient rehabilitation facilities when developing appeals.
- Collaborate with internal teams and payors to advocate for patient access to necessary care.